Acta Medica Croatica最新文献

The aim of this study was to examine the possibilities of measuring ADC/DWI values with the ROI method for precisedifferentiation of focal liver lesions from normal liver parenchyma. The study included 100 liver lesions sized ≥1 cm, previouslydetected in patients by ultrasound and computed tomography. It is done by measuring the diffusion coefficient ADC folder(MRI 3T), setting the ROI on the periphery of hepatic lesions, on the liver parenchyma around the focal hepatic lesions andon liver parenchyma that is distant to hepatic lesions. In our study, difference between the average ADC value of focalliver lesions (1.24 x10(-3) mm(2)/s) and normal liver parenchyma around focal liver lesions (1.001x10(-3) mm(2)/s) was statisticallyconfirmed. There was statistically proven difference in the average ADC values between normal liver parenchyma aroundfocal lesions and liver parenchyma located distant from focal lesions of (1.003x10-3 mm2/s). Wilcoxon rank test yieldeddifferences in the average (median) ADC values between total lesions in patients and liver parenchyma directly aroundfocal lesions (p<0.0005). Wilcoxon rank test showed no differences in the average (median) ADC between liver parenchymadirectly around focal lesions and distant of focal hepatic lesions (p<0.0005). The results obtained for each focal liver lesionwere compared with histopathology findings obtained by puncture or surgery, and for cystic lesions radiological follow upwas sufficient. For all liver lesions, the resulting overall DWI/ADC sensitivity was 92% and specificity 77%. Kendall’s tau-bcoefficient of concordance showed a statistically significant correlation between our DWI diagnosis and histopathologyverification for all liver lesions (p<0.0005). He mangiomas and cysts showed greatest difference in ADC values as comparedwith healthy liver. ADC values of hepatocellular carcinoma (HCC) and the surrounding normal liver parenchyma were notstatistically different, which can be explained by similarities in their cell structure. Related articles conclude that DWI hasinadequate sensitivity in detecting HCC, explaining this minimal difference in cellularity of well differentiated HCC and liverparenchyma. DWI/ADC has the potential to differentiate and reliably define the limits of focal lesions of the normal liverparenchyma. ADC delimitation of focal lesions of the liver parenchyma is most reliable for hemangiomas and cysts, whileADC delimitation of HCC can pose diagnostic difficulties.

The result of the increase in drug abuse is a growing number of patients receiving methadone or buprenorphinesubstitution therapy. Physicians are increasingly confronted with patients on substitution therapy at the time when theyare developing acute pain conditions or when they need surgery. Although pain has sensory qualities, it is a very personaland complex experience. The intensity and duration of pain are influenced by numerous factors. Poorly controlled painleads to unnecessary suffering of the patients with the possibility of permanent changes in behavior and reduced qualityof life. Efficacious pain treatment is considered a basic right of every patient. Because of the complex mechanisms of theemergence and transmission of pain and the emotional components that are involved in the experience of pain, appropriatepain relief in patients on substitution therapy is a major challenge for both the physicians and the patients. The article givesan overview of issues related to the treatment of acute pain and perioperative treatment in patients on substitution therapywith methadone and buprenorphine. The article highlights the wrong common misconception about pain treatment in thesepatients, which also are the most common cause of their inadequate treatment.

The remains of a tomb were discovered below the foundations of the Roman church of “Majka Bozja Gorska” in Lobor in2002. It was a vaulted tomb carved from a single stone. The narthex of ancient Christian and pre-roman churches oftenserved as the resting place of religious, secular and noble dignitaries, who were credited for founding the church at thetime. By anthropological methods, the age, gender, height, pathological changes, tendon and ligament hinges and degreeof development were able to be analysed. The stable isotopes of Carbon-13, Nitrogen-15 and Oxygen-18 were analysedand expressed as ��-values according to the PDB standard. Dental analysis showed a build-up of tartar on the buccal side,with 5 teeth missing from the dentition post-mortem and a partial lowering and accretion of the alveolar walls of the 2ndmolar space secondary to tooth loss. The remains of the person from grave 107 show that the person was approximately30-35 years of age, confirmed by microscopical analysis of the bone samples. Almost all of the cranial sutures wereexposed with the exception of the saggital suture which was closed at the S3 position, while the transverse palatal suturewas in the initial stages of closure on the lateral sides. Analysis of the iliac bone showed visible changes on the bone. Thesurface had retained its youthful appearance however with a microporous and pronounced granular structure and onlya slight apical and marginal activity. The transverse striations are still apparent, but no longer along the entirety of thebone surface. Anthropometric analysis according to cranial cavity indexes, showed a cranium or relatively large volume(aristencephalic in type), long, narrow and medium in height. The index values were used in facial reconstruction. Analysisof the development of tendon and ligament hinges of the preserved anatomical elements, gave further information aboutthe morphology and physical activity of the person. The hinge sites of the brachial and antebrachial muscles showed asignificant development and these enthesopathies would be consistent with a strenuous physical activity, especially at thebiceps tendon and shoulder girdle, portraying an anterior elevation, cubital flexion, pronation, circumduction and fixation. Itcan be said that the person predominantly used the left arm. The developed muscle hinges, show common pronatory andsupinatory movements and presume a routine swinging motion of an object above the head or in front of the person. Theleft tibia was suggestive of the height and male gender of the person. According to Pearson’s regression formula, for thelength of the brachium, radius and tibia, it can be reasoned that the person was approximately 169 cm tall. The upper thirdof the L3 vertebra shows a Schmorl’s hernia which can be secondary to strong anteroposterior and lateral flexion of thespine. On the supero-lateral surface of the left patella, there is a Messeri sign, suggestive of a long and

With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distalphalanx of the fingers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptomsare swelling and redness of the fingertip with nail deformity, while typical night pain may not be present. Unusual clinicaland x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-oldpatient reported pain in the fingertip of his right ring finger persisting for five years. Swelling and redness of the fingertipcombined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonanceimaging showed suspicion of osteoid osteoma, which was confirmed by computed tomography (CT). We performedsurgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateralside of the distal phalanx of the ring finger and the basal part of distal phalanx was cut with a small chisel to enable accessto cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sentfor histopathologic analysis. After surgery, the ring finger was immobilized in a plaster splint for a three-week period. Afterremoval of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtainthe full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoidosteoma, all symptoms disappeared completely. Histopathologic findings confirmed the diagnosis of osteoid osteoma.After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months aftersurgery, clinical findings were normal and the patient had no pain or discomforts. Full recovery was shown by the result ofthe DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx ofthe finger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearanceon x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. Forthis reason, it may be difficult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swellingand redness of the finger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layersof 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis.Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destructionof lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures,tendons and joints, the best method for treatment osteoid o

The aim was to determine usefulness of routine pathologic evaluation of uterine content after uterine evacuation followingthe diagnosis of abnormal early pregnancy. This retrospective descriptive study performed during a one-year period includedall patients diagnosed with abnormal early pregnancy clinically or by ultrasound in the first trimester. All patients had uterineevacuation. During the study period, 335 women were diagnosed with abnormal early pregnancy and referred for uterineevacuation. Pathology results were available for 312 women included in the analysis. In 272 (87.2%) women, trophoblasttissue was found on examination and therefore intrauterine pregnancy was confirmed. In the remaining 40 patients,trophoblast was not found. In 10 (3.2%) patients, gestational trophoblastic disease was diagnosed, not being suspectedon pre-evacuation assessment. In one patient, suspected molar pregnancy was excluded by pathology evaluation. Basedon 51/312 (16.3 %) patients where pathology examination of uterine content influenced further management and treatment,we believe that routine pathology examination of uterine content after uterine evacuation in the fi rst trimester followingabnormal early pregnancy is justifiable in clinical practice.

Although the etiology of the disease has not yet been fully clarified in the 21st century, clinical significance of the diseaseis huge because it is frequent in the neonatal period compared with other diseases. Today, owing to advanced diagnosticpossibilities, hypertrophic pyloric stenosis is easily distinguished from other differential diagnoses that are manifested byvomiting as the main symptom. At Department of Pediatric Surgery, Zagreb Children’s Hospital, efforts have been investedto successfully manage this and a number of other conditions that affect newborns. We retrospectively analyzed data on40 hospitalized children retrieved from the hospital information system for the 2010-2015 period and present them as abasis for the respective algorithms and future research. Reviewing a range of parameters, we have come to some concreteconclusions. On average, the disease started manifesting on 28th day after birth; 63% of the children developed metabolicalkalosis. Thickness of the muscle wall verified by ultrasound ranged from 3.1 mm to 7 mm. Surgery was performed sevendays after hospitalization and correction of metabolic condition. The average duration of surgery was 48 minutes. The meanlength of hospital stay was 11.64 days, of which 2 days in the intensive care unit. Complications occurred in two patients.

Viral hepatitis is a systemic disease that predominantly affects the liver. The most common causes of viral hepatitis are fi vehepatotropic viruses A, B, C, D and E; according to duration, it can be acute or chronic. Although clinical course of all viralhepatitides is similar, particular problem is predisposition of hepatitis B and hepatitis C to cause chronic forms of illnesswith severe outcome such as cirrhosis, hepatocellular carcinoma and liver failure. Clinical features include malaise, nausea,anorexia, low grade fever, aversion to smoking, and in clinical status usually we can fi nd hepatomegaly, and seldomsplenomegaly with adenopathy and jaundice. Generally, symptoms are very variable, from usually asymptomatic to fulminant,which in most cases have lethal outcome. There are three stages in acute phase of viral hepatitis: prodromal, icteric andconvalescence. Standard laboratory tests show elevated values of aspartate aminotransferase, alanine aminotransferaseand alkaline phosphatase in acute phase of hepatitis and elevated lactate dehydrogenase in chronic phase. Serum proteinelectrophoresis usually shows decreased albumin fraction and albumin/globulin ratio, as well as increased bilirubin level,positive urobilinogen and disturbance in coagulability factors, i.e. marked prolongation of prothrombin time. For etiology ofeach virus, series of serologic tests are used. In hepatitis A, acute phase of disease is characterized by IgM anti-HAV andpresence of IgG anti-HAV indicates previous exposure. In hepatitis B, appearance of HBsAg in serum is the fi rst evidenceof infection and recovery is connected with appearance of anti-HBsAg along with IgG anti HBcAg. Active forms of chronichepatitis B are characterized by active virus replication, which can be measured with polymerase chain reaction (PCR)HBV DNA. Diagnosis of hepatitis C is based on detection of antibodies to HCV (anti-HCV). Generally, it signifi es that HCVinfection is present but that diagnostic tool is poor for the phase of disease. In these circumstances, diagnosis of hepatitisC may be confi rmed by using an assay for HCV RNA. First line therapy in acute phase is mostly supportive, i.e. bed rest,appropriate diet including palatable meals as tolerated, without overfeeding. Alcohol and hepatotoxic agents (for example,paracetamol, amoxicillin, ketoconazole) should be avoided. In cases with increased tendency of developing chronic formsof hepatitis and complications (cirrhosis, hepatocellular carcinoma), immunomodulators should be administered, e.g.,interferon and/or antiviral agents. The role of family physician/general practitioner is in maintaining preventive measures(vaccination) and education of general population. Special attention needs to be paid to screening and educating high riskpatients with respect to proper diagnostics, laboratory and serologic tests. After establishing the diagnosis, all relevantmeasures should be taken to avoid chronifi cation o

Carotid endarterectomy is a common way of surgical treatment of extracranial carotid artery disease caused byatherosclerosis. Patients are often operated on under local anesthesia with intraoperative application of heparin.Postoperative bleeding occurs in up to 8% of cases, and up to 4.7% of patients need reoperation due to bleeding. TachoSilis a medical sponge consisting of collagen with added human coagulation factors (fibrinogen and thrombin). In contact withwater, blood or bodily fluids, it forms a clot that adheres to the surface. The hypothesis and aim of our study was to showthat TachoSil could be topically administered during surgery on carotid arteries in order to prevent minor bleeding, withoutcausing any local signs of inflammation or infection. The study included a prospective series of consecutive patients thatunderwent surgery for extracranial carotid stenosis with concomitant antiplatelet therapy at Department of Vascular Surgery,Merkur University Hospital in Zagreb. All patients received antiplatelet therapy with aspirin or aspirin and clopidogrel untilthe day before surgery. From April 2, 2012 to February 8, 2013, a total of 24 patients with extracranial carotid artery stenosiswere operated on, along with receiving antiplatelet therapy. All patients received 100 mg of acetylsalicylic acid and/or 75mg of clopidogrel until one day prior to surgery. Patients had been treated with antiplatelet drugs for at least six monthsprior to carotid endarterectomy. Four patients had been on dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg)because of percutaneous transluminal angioplasty (PTA) and a stent placed in pelvic arteries or superficial femoral artery.Due to speech disturbances following clamping of carotid arteries in two study patients a temporary intraluminal shunt wascreated. These two patients underwent longitudinal arteriotomy and longitudinal endarterectomy. Arteriotomy was closedby direct suture without a patch. Following arteriotomy and partial conversion of heparin with protamine, six patients neededadditional individual sutures. Then, protamine was added again to up to the full dose of conversion (50 mg). In 19 patients,only one TachoSil medical sponge (9.5 cm x 4.8 cm) was placed, whereas in fi ve patients two sponges were placed. Noneof the patients (24 of them operated on between April 2, 2012 and February 8, 2013) with TachoSil placed intraoperativelyhad any signs of postoperative wound infection. Carotid artery stenosis is a very common disease the incidence of whichincreases proportionally with age of the population observed. Bleeding is a relatively common and significant complicationfollowing surgical treatment, particularly in case of arterial bleeding. Bleeding and other complications in the neck can bevery serious and challenging for surgical treatment. With the present guidelines for the administration of clopidogrel in theevening before surgery, in some circumstances a

This article presents a historical review of the performance of 23 cesarean sections at the King’s Maternity Hospital andMidwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in thehospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most commonindication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the mostcommon complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overallperinatal mortality was 36.3% (stillbirths and early neonatal deaths).